I spend an extra 30 minutes at the end of a session this week helping a mom build her courage and confidence so that she felt ready to start toilet training soon. Her child is over 3, has sensory and motor issues, but shows tons of signs for readiness: dry diapers for increasingly long periods, tells adults when he needs to “go”, able to manage clothing, etc. He also has no confidence in his abilities, rarely likes change or challenge, and is super-sensitive to altering routines and using new environments. This isn’t going to be seamless.
It isn’t clear who is the more prepared individual, but I think it could be the child.
This mom read my favorite marketplace book on training “Oh Crap”, and she needs to re-read it with an eye to the many ways in which her child fits the picture of a child that could NEVER be fully ready to train. This species is so averse to novelty and challenge that no treat or toy is a great enough reward. Nothing is more frightening to them than failure, and you simply cannot miss the diaper. It is familiar, fail-proof, and allows children to never have to monitor their body signals or stop watching Paw Patrol to go to the potty. Ever.
This child is likely to be experiencing the normal sensations of fullness and pressure (as the bladder and rectum fill) as uncomfortable and a little scary. This interoceptive input can be one that children are sensitive to in the same way that the find seams on clothes or lying down for a diaper change unpleasant. He requires a lot of support to tolerate and process tactile input and vestibular input, so it isn’t exactly surprising that he would find interoceptive sensation difficult to handle. Adding a new routine for dealing with elimination, placing it in a room he rarely uses (the bathroom) and being old enough to know that he could “fail” and old enough to absorb outside comments about being “dirty” is more than enough to make this harder than it should be.
My suggestions to this mom included:
- Adding more vocabulary to her discussions about toilet training. Speaking about the feelings of pressure and fullness, the actions of pushing the poop out gently, and cleaning/wiping with clear messaging that this is a learning experience that nobody does perfectly. Hearing that his parents had “accidents” when they were little, and that every child will have accidents, well, this could really help both of them.
- Dressing him lightly, or choosing to go naked or just underpants (I like two layers of training pants if they still fit his tiny heine!) so that there are fewer barriers to making it to the potty means she may need to shop for training garments.
- Planning the environment if she is going to let him go naked. All living events except sleeping need to happen in places where accidents can be cleaned up easily. She isn’t averse to staining the carpet, but I assured her that her child knows not to spill things on that carpet. He is too old not to interpret soiling it as a failure. When she runs to clean it up, he will feel badly. If she doesn’t have to rush and shows no stress, he will relax about the almost inevitable accident. He NEEDS the confidence to move forward.
- Consider more media about toileting and the arc of learning. Most children don’t like to talk about things that distress them. But they LOVE to read about others who are going through the same things. I suggested that she weave in some new books about characters who are learning to use the toilet, and add comments about their feelings as they learn. This would include how excited and proud the character is. Proud can be a new word in his vocabulary!
Training a child that has low tone? I wrote an e-book for you!
The Practical Guide to Toilet Training Your Child With Low Muscle Tone is filled with preparation ideas, strategies to address the common issues of sensory processing limitations and the behavioral effects of low tone, and even includes a guide to building readiness instead of waiting for it to arrive! You can find it on my website Tranquil Babies, on Amazon , and on a terrific site for occupational therapy materials, Your Therapy Source